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Abstract：
To evaluate the diagnostic accuracy of matrix-assisted laser desorption ionization time-of-flight mass spectrometry based on nucleotide (nucleotide MALDI-TOF MS) on bronchoalveolar lavage fluid (BALF) from suspected pulmonary tuberculosis (PTB) patients. A retrospective study was conducted on suspected PTB patients (total of 960) admitted to Chongqing Public Health Medical Center between May 2021 and January 2022. The sensitivity, specificity, positive predictive value, negative predictive value (NPV) and area under the curve values of nucleotide MALDI-TOF MS as well as smear microscopy, Mycobacterium Growth Indicator Tube 960 culture (MGIT culture), and Xpert MTB/RIF were calculated and compared. Total of 343 presumed PTB cases were enrolled. Overall, using the clinical diagnosis as reference, the sensitivity and NPV of nucleotide MALDI-TOF MS was 71.5% and 43.1%, respectively, significantly higher than smear microscopy (22.6%, 23.2%), MGIT culture (40.6%, 18.9%), Xpert MTB/RIF (40.8%, 27.9%). Furthermore, nucleotide MALDI-TOF MS also outperformed over Xpert MTB/RIF and MGIT culture on smear-negative BALFs. Approximately 50% and 30% of patients benefited from nucleotide MALDI-TOF MS compared with smear and MGIT culture or Xpert MTB/RIF, respectively. This study demonstrated that the analysis of BALF with nucleotide MALDI-TOF MS provided an accurate and promising tool for the early diagnosis of PTB.
摘要：
评价基于核苷酸MALDI-TOFMS的基质辅助激光解吸电离飞行时间质谱对疑似肺结核(PTB)患者支气管肺泡灌洗液(BALF)的诊断准确性。对2021年5月至2022年1月重庆公共卫生医学中心收治的疑似PTB患者(共960例)进行回顾性研究。敏感性,特异性，正预测值，阴性预测值（NPV）和核苷酸MALDI-TOFMS的曲线下面积值以及涂片显微镜，分枝杆菌生长指示管960培养（MGIT培养），计算并比较XpertMTB/RIF。共纳入343例推测的PTB病例。总的来说,以临床诊断为参考，核苷酸MALDI-TOFMS的灵敏度和NPV分别为71.5%和43.1%，分别,显著高于涂片镜检(22.6%，23.2%），MGIT文化(40.6%，18.9%），XpertMTB/RIF（40.8%，27.9%）。此外，核苷酸MALDI-TOFMS也优于涂片阴性BALF上的XpertMTB/RIF和MGIT培养物。与涂片和MGIT培养或XpertMTB/RIF相比，约有50％和30％的患者受益于核苷酸MALDI-TOFMS，分别。这项研究表明，用核苷酸MALDI-TOFMS分析BALF为PTB的早期诊断提供了准确和有前途的工具。
